The Scottish Government has proposed reducing the number of NHS health boards from 14 to two as part of a broader programme of public-sector reform for 2026–31, ministers confirmed on Tuesday.
Centralisation plan prompts concerns for island services
First Minister John Swinney outlined the measures while updating the Scottish Parliament on the government’s latest programme for government. The announcement said the reforms seek to increase efficiency across the public sector and explore new delivery models for services.
While ministers signalled a willingness to allow tailored arrangements for island communities, councillors in Shetland and elsewhere have warned that the proposals as announced lack sufficient detail about how remote and rural services will be protected.
“Through reform we remain committed to enabling bespoke solutions for our island communities recognising their unique characteristics, including exploration of the single authority model.”
The programme also put forward the concept of a single authority model, combining councils and health boards into a unified local authority where communities wish to pursue it. The idea is not new and has previously been discussed in several island council chambers.
Island councils cautious after earlier opposition
Officials in Shetland have previously been reluctant to pursue a single authority approach. Last year the council’s chief executive indicated the authority preferred to observe other areas in any such reorganisation rather than lead change itself. The Western Isles have shown more openness to the model, underscoring the patchwork of local views across Scotland’s island communities.
Orkney’s representative in the Scottish Parliament, Liam McArthur, voiced the worry shared by many islanders: centralising health boards risks overlooking the practical challenges of delivering care in remote settings, including travel distances, workforce recruitment and the viability of local services. MSPs and councillors say those practicalities must be addressed before any merger of boards proceeds.
What is proposed — and what is not yet settled
The government has confirmed a programme of far-reaching public-sector reform intended to deliver efficiency savings and reshape how services are organised. At this stage the proposals identify structural changes rather than specifying the operational arrangements that would follow.
| Current | Proposed |
|---|---|
| 14 health boards | 2 health boards |
The announcement also noted an intention to reduce the number of government organisations and suggested some bodies might be brought closer into core departments — Transport Scotland was cited as an example.
- Key concerns— island and rural representatives want clear protections for local services and staffing.
- Single authority model— offered as an option for areas that wish to pursue integration of council and health functions.
- Detail lacking— ministers have set direction, but operational plans, governance arrangements and transition timetables have not been published.
Evidence and limits
Internationally, research into regional consolidation of health services shows mixed results: some reorganisations produce efficiency gains while others encounter transitional costs, service disruption and challenges maintaining access in rural areas. The balance of impact typically depends on implementation detail — how services are reconfigured, workforce plans, and safeguards for remote communities. That nuance is not yet present in the Scottish plan as announced.
Ministers have signalled the government will explore bespoke arrangements for island areas, but local leaders say they need concrete guarantees on funding, staffing and protected local services before they can judge the proposals. Until formal consultation documents and impact assessments are published, it will be difficult for stakeholders to evaluate potential benefits and risks.
The announcement marks a significant shift in structure for Scotland’s health governance and will trigger scrutiny from local authorities, clinicians and patient groups. The coming weeks and months are likely to see calls for detailed transition plans, equality and accessibility impact assessments, and assurances that the unique needs of island and rural populations will not be lost in a drive for centralisation.
Officials have not yet provided a timetable for legislative change or detailed governance proposals. Parliamentarians and council leaders say they expect more information and formal consultations before any reorganisation proceeds.
